Search

Instructional quality is associated with better academic outcomes for students. This study aimed to investigate how teachers' job satisfaction was associated with clarity of instruction and cognitive activation as measures of instructional quality. In addition, we investigated whether this association between teachers' job satisfaction and instructional quality was mediated by teacher-student relationships. Drawing on the 2018 Teaching and Learning International Survey (TALIS), we compared participants from both Eastern (N = 27,106; Japan, Taipei, Korea, Shanghai) and Western sociocultural contexts (N = 20,209; Canada, Australia, New Zealand, United States, United Kingdom). Multilevel structural equation modelling results indicated that teachers' job satisfaction was positively associated with instructional quality across Eastern and Western settings. The relationship between teachers' job satisfaction and instructional quality was partially mediated by better student-teacher relationships. There were some differences between the cultural settings in how job satisfaction correlated with clarity of instruction and cognitive activation. We suggest that these differences may be accounted for by cultural characteristics leading to different approaches to teaching. Our results suggest that teachers' job satisfaction and the quality of classroom-level relationships may be important indicators of positive instructional outcomes. While schools focus on student outcomes, they should also address teachers' job satisfaction and prioritise the importance of relationships between teachers and students in classrooms.

Earth wires and fuses work together in UK mains circuits to keep users safe from electric shocks and are taught in many school contexts. The subject can be quite abstract and difficult for pupils to grasp, and a simple but visually clear and direct demonstration is described which would be easy for most physics departments to build and which can make the concepts much more immediately understandable.

The maximum power theorem is a useful extension to work on EMF and internal resistance at school level. Furthermore, a very simple physical collision model can be used to show equivalent mathematical patterns to those found with the maximum power theorem and to emphasize fundamental links to ideas of impedance matching. (Contains 2 tables and 6 figures.)

The author reflects on military medical care in Great Britain as of October 2014. He provides a background of military medical care which experienced a turning point during World War I that was the first major conflict. He examines the improvements in medicine and hygiene as well as the geographical factors that affect military medical care. He notes that combatant nations during World War I were more prepared when they entered World War II.

Objective. Psychiatric medications have clear links to obesity, diabetes, dyslipidaemia, hypertension, hyperprolactinaemia and movement disorders. These disorders are a common cause of morbidity and mortality in psychiatric patients but physical screening by health services is often haphazard. Methods. We report the findings of an audit of physical screening across two hospital wards. Each ward undertook a process of service improvement. One ward modified the admissions proforma and the other developed a discharge screening clinic. The effectiveness of each of these interventions was then compared through a reaudit of practice across both wards. Results. At baseline, screening was performed inconsistently and infrequently. On average, the modified admissions proforma increased screening rates by 4.7% compared to 30.7% for discharge screening clinics. The discharge screening clinic demonstrated statistically significant improvements in screening rates and effectively delivered health promotion advice. Conclusions. Discharge screening clinics are significantly more likely than improved admissions procedures to detect clinically significant abnormalities. If these abnormalities are detected and treated then the long-term physical health of psychiatric patients may be improved. [ABSTRACT FROM AUTHOR]

GPs may be required to assist in the administration of Mental Health or Mental Capacity Legislation. Although infrequent, this process can be complicated and time consuming. Due to different legal systems, the role of the GP in civil commitment varies considerably throughout the UK. This article aims to give a brief overview of the main pieces of legislation in the different areas of the UK, England and Wales, Scotland and Northern Ireland, and to assist the GP in navigating the practicalities of applying the law to clinical cases. [ABSTRACT FROM PUBLISHER]

dult rheumatologists in the UK have historically provided a significant contribution to clinical care for children with rheumatic disease. However, changes in postgraduate training have resulted in adult rheumatology trainees no longer being trained in paediatric rheumatology (PRh), and accordingly, they will be ill-equipped to manage children when incumbent adult rheumatology specialists retire. The objectives of this work were to ascertain the number of UK adult rheumatologists currently involved in PRh care and to inform future workforce planning. As part of the British Society for Rheumatology annual consultant workforce survey, additional questions relating to PRh were included. A questionnaire was sent to 584 adult rheumatologists, of whom 403 (69%) responded to questions about PRh; of these, 75 of 403 (19%) reported seeing children and many will retire in the next 5 and 10 years (13/75 (18%) and 35/75 (48%), respectively). The majority (58/75, 78%) reported having separate clinics for children, often alongside other health care professionals (mostly consultant paediatrician, paediatric rheumatologist, or allied health professional). Notably, 4 of 75 (5%) adult rheumatologists had clinical sessions seeing children without any paediatric input. The median (IQR) number of paediatric consultations by adult rheumatologists per month was 10 (6, 15), equating to a total 931 paediatric consultations per average month. Many UK adult rheumatologists are involved in managing paediatric rheumatic disease and many will retire over the next 10 years. This will result in a shortfall in clinical provision as their replacements in adult rheumatology will not have had appropriate PRh training. This projected shortfall needs to be addressed in future workforce planning. [ABSTRACT FROM AUTHOR]

The objective of this study was to describe the provision of consultant rheumatology services and the pattern of inequalities in UK rheumatology service provision, and to summarise the five-year impact of the new NHS consultant contract and the Musculoskeletal Services Framework in England and Wales. All consultants on the British Society for Rheumatology/Arthritis Research UK Consultant Workforce Register in January 2007 and January 2009 were sent questionnaires about timetable and working conditions and the personal and job-related details currently held about them on the register. Response rates were 87% in 2007 and 86% in 2009. The number of whole-time equivalent (WTE) rheumatologists in the UK increased from 470 to 531 (13%). Levels of provision in 2009 were lower in Scotland (1 WTE per 113,286 population) than the rest of the UK. There are now few regional variations in rheumatology consultant provision within the UK, and the number of WTE consultants is approaching recommended levels. [ABSTRACT FROM AUTHOR]

Abstract: Human bite injuries are a common injury, roughly accounting for around 0.1% of attendances to Emergency Medicine departments. Morbidities associated with such injuries are legion. Of paramount importance is the potential for infection of the wound site, both bacterial and viral. A retrospective 4-year review of 3136 case notes was conducted, identifying 421 human bites. This amounts to one every 3 days! The majority of those bitten were young males (male:female ratio=3:1; 44% comprising the age group 16–25 years). The management of these wounds was found to be poor. 17% of patients did not receive any antibiotic cover; 21% of patients either did not have tetanus prophylaxis administered when required or had a tetanus booster when they were already covered; 34% of patients either did not receive a hepatitis B booster when one was required or received one when they were already covered. This lack of effective documentation, along with errors in addressing prophylaxis of the infective agents, may have profound medico-legal consequences. The author believes that the findings will be reproduced in other centres and in view of the inadequacies highlighted by this work, it is necessary to introduce an evidence-based protocol for the comprehensive management of the human bite. Using United Kingdom Department of Health evidence-based guidelines, the author proposes such a pathway. [Copyright &y& Elsevier]

The last few decades have witnessed a flowering of interest in the history of science in the British Empire. This essay aims to provide an overview of some of the most important work in this area, identifying interpretative shifts and emerging themes. In so doing, it raises some questions about the analytical framework in which colonial science has traditionally been viewed, highlighting interactions with indigenous scientific traditions and the use of network-based models to understand scientific relations within and beyond colonial contexts. [ABSTRACT FROM AUTHOR]

Assesses the transition of medical astrology into medical astronomy in Great Britain. Emergence of sol-lunar theories of disease; Basis for the views concerning the influence of heavenly bodies on human health; Factors affecting the popularity of medical astronomy; List of books written about the influence of celestial bodies on human health.

The article focuses on an index of total munitions output of Great Britain during the second World War prepared by E.A.G. Robinson, head of Programs Division of the British Ministry of Production. The Ministry was set up in February 1942 in order to coordinate war production under conditions of acute generalized shortage in the economy as a whole. According to Robinson, the index was considered to be rather secret at the time; it was not passed on to the Central Statistical Office then or subsequently, and this is why it was not eventually published in the Statistical digest of the war or in any companion volumes of the British civil series of the official History of the second World War. The Robinson index was reported weekly and monthly. It covered three main kinds of military goods: army equipment, aircraft, and warships. The original figures underlying the Robinson index cannot be pinpointed with accuracy. Tests show, however, that the quarterly movement of the monthly index is satisfactorily replicated by combining the Ministry of Supply index of finished output of total warlike stores, published after the war, with total structure weight of finished aircraft, also published after the war, and with series based on wartime estimates of quarterly employment on Admiralty orders with the appropriate lag.

A letter to the editor is presented which suggests to medical schools in Great Britain to review their admissions criteria to address the under-representation of men entering the medical profession by putting more emphasis on caring and compassionate qualities that make a good general practitioner.

• The optimal non-surgical management for LRRC is unknown. • Median OS after SABR reirradiation is encouraging. • Optimization of SABR for LRRC could further improve QoL and outcomes. • Further data is required before SABR is established as an alternative to surgery. Locally recurrent rectal cancer (LRRC) is associated with considerable morbidity, poor quality of life and an overall survival of 9 months. The non-operative treatment of LRRC is an understudied area, there is no consensus on management in this setting. We aim to perform a retrospective, multicentre analysis of patients treated with SABR reirradiation. All patients were identified who received SABR re-irradiation for LRRC, at 3 UK centres, between August 2015 and September 2020. Eligible patients had pelvic recurrence and were either not suitable/opted not for surgery, or margin positive after exenturative surgery. Patients were treated with 30 Gy in 5 fractions and followed up with clinical review and CT scan at 3, 6, 12, 18 and 24 months. 69 patients with 81 lesions were identified and median follow up was 28 months. Median progression free survival (PFS) and overall survival (OS) were 12.1 months (10.4, 17.7) and 38.7 months (28.9,-) respectively. 2-year OS was 0.77 (0.66, 0.89). 58.3% of deaths were as a result of consequences of local relapse. 42.6% of patients had local relapse at death or last follow up. Our outcomes are encouraging for a population who had R1 resections, refused or were refused surgery; as they are similar to those in surgical series. Prospective data including details of survival, local relapse and QOL; with an optimised SABR technique, is required to establish SABR as an alternative to surgery. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Preliminary results of the UK Anal Cancer Trial (ACT) II trial in squamous cell carcinoma of the anus (SCCA) are promising, but 2-D planning with parallel–opposed fields provoked significant toxicity. We calculated likely doses delivered in the ACT II protocol to the planning target volume (PTV), nodal clinical target volumes (n-CTV) and organs at risk (OARs). Methods and Materials: Original planning CT datasets of 33 consecutive patients with SCCA, included in the ACT II trial or treated to an identical protocol, enabled dose to the primary tumour, involved nodal PTV’s, uninvolved nodal CTVs (inguino-femoral and pelvic lymph nodes) and femoral heads to be retrospectively calculated. Results: The mean dose delivered to primary PTV was 51.37±1.68Gy (95% CI), with a maximum dose (D max) of 54.63±2.68Gy (95% CI). Involved inguinal nodes received a mean 51.41±3.08Gy, D max 54.17±2.84Gy (95% CI). Clinically uninvolved nCTVs received a mean 36.53±3.38Gy (inguinal nodes) and 34.15±5.59Gy (external/internal iliac nodes). Femoral heads received a D max of 47.32±3.45 (95% CI). Conclusion: Calculating the likely doses delivered in ACT II from chemoradiation to PTV, n-CTV and OARs facilitates specification of nodal doses and constraints for 3D-conformal/IMRT planning and allows rational dose-escalation for T3/T4 tumours, and potential dose-reduction for T1/T2 tumours. [Copyright &y& Elsevier]

Abstract: A 2010 UK police search for a clandestine burial highlighted the need for more information and quantitative data to aid coastal beach searches. This study aimed to address this by establishing relevant forensic search methodologies to aid the search for clandestine coastal burial sites, using the North West English coastline as a search area. A set of parameters were established, including criteria such as tidal range, proximity to vehicular access points and distance from inhabited areas, which may inform forensic searches by prioritising likely locations of clandestine burials. Three prioritised coastal locations were subsequently identified: (1) coastal dunes at Formby, (2) coastal dunes and (3) beach foreshore at Southport, all sites part of the Liverpool City Region in the United Kingdom. At all locations, simulated clandestine graves were hand-dug by spades into which a naked adult-sized, metal-jointed fiberglass mannequin was buried at 0.5m below ground level. Trial geophysical surveys were then undertaken with the aim of identifying the optimal geophysical instrumentation and technique to deploy in such environments. GPR data showed 450MHz frequency antennae to be optimal, with significantly poor data obtained from the foreshore area due to saline seawater. Electrical resistivity and magnetic susceptibility surveys were successful in coastal environments in target detection (albeit not in non-vegetated sand dunes), with resistivity fixed-offset configurations deemed optimal. The latter survey successes may be due to the recent disturbed ‘grave’ rather than the target, which itself is of interest in terms of identifying the most recent clandestine burials. [Copyright &y& Elsevier]

Genomic testing is becoming routine for diagnosing rare childhood genetic disease. Evidence underlying sustainable implementation is limited, focusing on short-term endpoints such as diagnostic yield, unable to fully characterize patient and family valued outcomes. Although genomic testing is becoming widely available, evidentiary and outcomes uncertainty persist as key challenges for implementation. We examine whether the current evidence base reflects public tolerance for uncertainty for genomics to diagnose rare childhood genetic disease. We conducted focus groups with general population parents in Vancouver, Canada, and Oxford, United Kingdom, to discuss expectations and concerns related to genomic testing to diagnose rare childhood genetic disease. Applying a purposive sampling technique, recruitment continued until thematic saturation was reached. Transcripts were analysed using thematic analysis. Thirty-three parents participated across four focus groups. Participants valued causal diagnoses alongside management strategies to improve patient health and wellbeing. Further, participants valued expanding the evidence base to reduce evidentiary uncertainty while ensuring security of information. Willingness to pay out of pocket for testing reflected perceived familial health benefit. Diagnostic yield fails to fully capture valued outcomes, and efforts to resolve uncertainty better reflect public priorities. Evaluations of genomic testing that fully integrate valued endpoints are necessary to ensure consistency with best practices and public willingness to accept the uncertain familial benefit., (© 2021. Crown.)

Background: Oxaliplatin and fluoropyrimidine chemotherapy administered over 6 months is the standard adjuvant regimen for patients with high-risk stage II or III colorectal cancer. However, the regimen is associated with cumulative toxicity, characterised by chronic and often irreversible neuropathy., Objectives: To assess the efficacy of 3-month versus 6-month adjuvant chemotherapy for colorectal cancer and to compare the toxicity, health-related quality of life and cost-effectiveness of the durations., Design: An international, randomised, open-label, non-inferiority, Phase III, parallel-group trial., Setting: A total of 244 oncology clinics from six countries: UK (England, Scotland, Wales and Northern Ireland), Denmark, Spain, Sweden, Australia and New Zealand., Participants: Adults aged ≥ 18 years who had undergone curative resection for high-risk stage II or III adenocarcinoma of the colon or rectum., Interventions: The adjuvant treatment regimen was either oxaliplatin and 5-fluorouracil or oxaliplatin and capecitabine, randomised to be administered over 3 or 6 months., Main Outcome Measures: The primary outcome was disease-free survival. Overall survival, adverse events, neuropathy and health-related quality of life were also assessed. The main cost categories were chemotherapy treatment and hospitalisation. Cost-effectiveness was assessed through incremental cost comparisons and quality-adjusted life-year gains between the options and was reported as net monetary benefit using a willingness-to-pay threshold of £30,000 per quality-adjusted life-year per patient., Results: Recruitment is closed. In total, 6088 patients were randomised (3044 per group) between 27 March 2008 and 29 November 2013, with 6065 included in the intention-to-treat analyses (3-month analysis, n  = 3035; 6-month analysis, n  = 3030). Follow-up for the primary analysis is complete. The 3-year disease-free survival rate in the 3-month treatment group was 76.7% (standard error 0.8%) and in the 6-month treatment group was 77.1% (standard error 0.8%), equating to a hazard ratio of 1.006 (95% confidence interval 0.909 to 1.114; p -value for non-inferiority = 0.012), confirming non-inferiority for 3-month adjuvant chemotherapy. Frequent adverse events (alopecia, anaemia, anorexia, diarrhoea, fatigue, hand-foot syndrome, mucositis, sensory neuropathy, neutropenia, pain, rash, altered taste, thrombocytopenia and watery eye) showed a significant increase in grade with 6-month duration; the greatest difference was for sensory neuropathy (grade ≥ 3 was 4% for 3-month vs.16% for 6-month duration), for which a higher rate of neuropathy was seen for the 6-month treatment group from month 4 to ≥ 5 years ( p  < 0.001). Quality-of-life scores were better in the 3-month treatment group over months 4-6. A cost-effectiveness analysis showed 3-month treatment to cost £4881 less over the 8-year analysis period, with an incremental net monetary benefit of £7246 per patient., Conclusions: The study achieved its primary end point, showing that 3-month oxaliplatin-containing adjuvant chemotherapy is non-inferior to 6 months of the same regimen; 3-month treatment showed a better safety profile and cost less. For future work, further follow-up will refine long-term estimates of the duration effect on disease-free survival and overall survival. The health economic analysis will be updated to include long-term extrapolation for subgroups. We expect these analyses to be available in 2019-20. The Short Course Oncology Therapy (SCOT) study translational samples may allow the identification of patients who would benefit from longer treatment based on the molecular characteristics of their disease., Trial Registration: Current Controlled Trials ISRCTN59757862 and EudraCT 2007-003957-10., Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 23, No. 64. See the NIHR Journals Library website for further project information. This research was supported by the Medical Research Council (transferred to NIHR Evaluation, Trials and Studies Coordinating Centre - Efficacy and Mechanism Evaluation; grant reference G0601705), the Swedish Cancer Society and Cancer Research UK Core Clinical Trials Unit Funding (funding reference C6716/A9894)., Competing Interests: Timothy Iveson reports honoraria from Amgen Inc. (Thousand Oaks, CA, USA), Bayer AG (Leverkusen, Germany), Bristol-Myers Squibb (New York, NY, USA), Celgene Corporation (Summit, NJ, USA), Pierre-Fabre (Paris, France), Roche (Roche Holding AG, Basel, Switzerland) and Servier (Laboratories Servier, Suresnes, France). Kathleen A Boyd reports grants from the Medical Research Council during the conduct of the study. Mark P Saunders reports personal fees from Servier, Amgen, Merck (Merck and Co., Kenilworth, New Jersey, USA), Eisai (Eisai Co., Ltd., Tokyo, Japan) and Roche outside the submitted work. Jim Cassidy reports grants from the Medical Research Council during the conduct of the study and is currently an employee of Celgene Corporation. Josep Tabernero reports personal fees from Array Biopharma (Boulder, CO, USA), AstraZeneca (Cambridge, UK), Bayer AG (Leverkusen, Germany), BeiGene (Beijing, China), Boehringer Ingelheim (Ingelheim am Rhein, Germany), Chugai (Chugai Pharmaceutical Co., Tokyo, Japan), Genentech, Inc. (South San Francisco, CA, USA), Genmab A/S (Copenhagen, Denmark), Halozyme (Halozyme Therapeutics, San Diego, CA, USA), Imugene Limited (Sydney, NSW, Australia), Inflection Biosciences Limited (Blackrock, Dublin), Ipsen (Paris, France), Kura Oncology (San Diego, CA, USA), Eli Lilly and Company (Indianapolis, IN, USA), Merck, Menarini (The Menarini Group, Florence, Italy), Merck Serono (Rockland, MA, USA), Merrimack Pharmaceuticals (MA, USA), Merus (Utrecht, the Netherlands), Molecular Partners (Molecular Partners AG, Zurich, Switzerland), Novartis (Novartis International AG, Basel, Switzerland), Peptomyc, Pfizer Inc. (New York, NY, USA), Pharmacyclics (Pharmacyclics LLC, Sunnyvale, CA, USA), ProteoDesign SL (Barcelona, Spain), Rafael Pharmaceuticals (Stony Brook, NY, USA), F. Hoffmann-La Roche Ltd, Sanofi (Sanofi S. A., Paris, France), Seattle Genetics (Bothwell, WA, USA), Servier, Symphogen (Symphogen A/S, Ballerup, Denmark), Taiho Pharmaceutical (Tokyo, Japan), VCN Biosciences (Barcelona, Spain), Biocartis (Biocartis Group, Mechelen, Belgium), Foundation Medicine (Cambridge, MA, USA), HalioDX (Marseille, France), SAS Pharmaceuticals (Delhi, India) and Roche Diagnostics outside the submitted work. Bengt Glimelius reports support from PledPharma AB for being on advisory boards. Sherif Raouf reports grants, personal fees and non-financial support from Roche, grants and personal fees from Amgen, and grants and personal fees from Merck outside the submitted work. David Farrugia reports that he received honoraria for speaking in educational events and support for meeting attendance from Bristol-Myers Squibb, Novartis, Ipsen, Amgen, AstraZeneca and Merck. David Cunningham reports grants from 4SC (4SC AG, Planegg, Germany), AstraZeneca, Bayer, Amgen, Celgene, Clovis Oncology (Boulder, CO, USA), Eli Lilly and Company, Janssen Pharmaceuticals (Beerse, Belgium), MedImmune (Gaithersburg, MD, USA), Merck, Merrimack and Sanofi, outside the submitted work. Tamish Hickish reports grants from Pfizer, Roche, Pierre Fabre (Paris, France) and personal fees from Eli Lilly and Company during the conduct of the study. John Bridgewater reports funding from the University College London Hospitals NHS Foundation Trust/University College London Biomedical Research Centre. David Cunningham reports funding from the National Institute for Health Research Biomedical Research Centres at the Royal Marsden.

Introduction: Survival in metastatic colorectal cancer is worse than expected in the United Kingdom. Real-world data are needed to better understand UK-specific treatment practices that may explain this., Patients and Methods: The Avastin ColORectal Non-interventional (ACORN) study is a multicenter, prospective, UK-based, observational, phase 4 study (ClinicalTrials.gov, NCT01506167) that recruited patients with metastatic colorectal cancer scheduled to receive bevacizumab in combination with first-line chemotherapy as part of routine clinical practice. Primary end points included progression-free survival, overall survival (OS), serious adverse events (AEs), and grade 3 to 5 bevacizumab-related AEs., Results: A total of 714 patients were recruited between August 30, 2012, and February 4, 2014. Median follow-up was 16.4 months. Median first-line chemotherapy duration was 5.6 months, with capecitabine/oxaliplatin (265 [37.1%]) being the most common regimen. Median total chemotherapy duration was 8.1 months and did not vary by geographic location in the UK. Median progression-free survival (95% confidence interval) was 8.7 (8.2-9.1) months, and median OS was 17.8 (16.1-19.3) months. There was no significant difference in efficacy by chemotherapy regimen administered. Ninety-nine patients (13.9%) received bevacizumab after disease progression. The safety profile of bevacizumab was consistent with previous studies., Conclusion: ACORN provided evidence that there were no clear differences observed in outcomes between bevacizumab with capecitabine-based chemotherapy and fluorouracil-based regimens, and confirmed the safety profile of bevacizumab in a real-world UK-based population. The lower-than-expected OS is likely due to the short total chemotherapy duration, less frequent use of bevacizumab after disease progression, and higher rates of in-situ primary tumors., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: In the decades following the discovery of the bacillus causing typhoid, in 1880, understanding of the disease formerly known as enteric fever was transformed, offering new possibilities for prevention. Gradually, measures that aimed to prevent infection from human carriers were developed, as were inoculations designed to confer immunity against typhoid and paratyphoid fevers. These were initially introduced in European armies that were regularly ravaged by typhoid, especially garrisons stationed in the colonies. This article reviews the research undertaken in the armed forces and the measures that they implemented in the years up to and during the First World War., Methods: The article is based on an analytical review of scientific literature from the early 19th century, focusing on the United Kingdom, Germany, and France., Results: The armies of the United Kingdom, Germany, and France undertook important work on the transmission of typhoid in the years between 1890 and 1918. Many preventive measures were introduced to deal with the spread of typhoid but these varied between the 3 countries, depending largely on their political traditions. Inoculation was particularly successful in preventing typhoid and greatly reduced the number of casualties from this disease during the First World War. Despite this, it proved difficult to prevent paratyphoid infection, and debates continued over which vaccines to use and whether or not immunization should be voluntary., Conclusions: By the end of the First World War, the value of inoculation in preventing the spread of typhoid had been proven. Its successful implementation demonstrates the importance of vaccination as a public health intervention during times of conflict and social upheaval., (© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.)

Purpose: Chemoradiation therapy (CRT) with mitomycin C (MMC) and 5-fluorouracil (5-FU) is established as the standard of care for the radical treatment of patients with anal squamous cell carcinoma (ASCC). The use of the oral fluoropyrimidine-derivative capecitabine is emerging as an alternative to 5-FU despite limited evidence of its tolerability and toxicity., Methods and Materials: A national cohort evaluation of ASCC management within the United Kingdom National Health Service was undertaken from February to July 2015. The toxicity rates were prospectively recorded. For the present analysis, we report data from ASCC patients who underwent intensity modulated RT and a single dose of MMC with either 5-FU (5-FU/MMC) or capecitabine (capecitabine/MMC). All were treated with radical intent and intensity modulated radiation therapy (IMRT) was delivered in accordance with UK guidance., Results: Of the 242 patients received from 40 centers across the United Kingdom, 147 met the inclusion criteria; 52 of whom were treated with capecitabine/MMC and 95 with 5-FU/MMC. No treatment-related deaths and no overall difference were found in the proportion of patients experiencing any grade ≥3 toxicity between the capecitabine and 5-FU groups (45% vs 55%; P = .35). However, significantly fewer patients in the capecitabine/MMC group experienced grade 3 hematologic toxicity (4% vs 27%; P = .001). A lower proportion of patients completed their planned chemotherapy course in the capecitabine cohort, although this did not reach statistical significance (81% vs 90%; P = .21). The median RT duration was 38 days (interquartile range 38-39) for both groups. No difference was found in the 1-year oncologic outcomes., Conclusions: Capecitabine/MMC resulted in similar levels of grade 3/4 toxicity overall compared with 5-FU/MMC as CRT for ASCC, although differences were found in the patterns of observed toxicities, with less hematologic toxicity with capecitabine. Further studies of capecitabine/MMC are required to understand the acute toxicity profile and long-term oncologic outcomes of this combination with intensity modulated RT for ASCC., (Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.)

Objective: Patients accessing the chronic disease self-management programme (CDSMP) often report multiple long-term conditions (multimorbidity). Although multimorbidity often predicts poor outcomes, CDSMP effectiveness may be enhanced in multimorbidity via synergies between self-management for different conditions. This study assessed whether CDSMP benefits varied by patterns of multimorbidity., Methods: The study was based on a secondary analysis of an RCT. Patients with long-term conditions (n=629) were randomised to CDSMP or wait-list and completed baseline and 6 month assessments. We identified four multimorbidity groups: (1) single physical condition; (2) multiple physical conditions; (3) single physical condition plus 'probable depression'; (4) multiple physical conditions plus 'probable depression'., Results: Multimorbidity group significantly moderated the effect of CDSMP on vitality, health-related quality of life, and mental well-being, with the greatest benefit found for patients with multiple physical conditions plus 'probable depression'., Conclusion: The coexistence of depression and multiple physical conditions is associated with increased illness burden, but such patients benefit more from the CDSMP. The mechanisms underlying this effect are unclear, but it does not appear to be through self-management or self-efficacy., Practice Implications: The presence of multimorbidity in combination with depression may be a useful criteria for referral to the CDSMP., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)